Prevalence of, and predictors of, bile acid diarrhea in outpatients with chronic diarrhea: A follow-up study.

Published on Sep 1, 2019in Neurogastroenterology and Motility2.946
· DOI :10.1111/NMO.13666
Shujing Jane Lim1
Estimated H-index: 1
(St James's University Hospital),
David J. Gracie16
Estimated H-index: 16
(University of Leeds)
+ 5 AuthorsChristopher J Black12
Estimated H-index: 12
(University of Leeds)
BACKGROUND: 23-seleno-25-homo-tauro-cholic acid (SeHCAT) scanning to rule out bile acid diarrhea (BAD) in patients with chronic diarrhea has a high yield. Our previous study showed that patients with terminal ileal (TI) Crohn's disease, TI resection, or cholecystectomy were highly likely to have an abnormal scan. As a result, we encouraged clinicians to use a therapeutic trial of a bile acid sequestrant in these patients, instead of scanning. This may have reduced diagnostic yield of the test, so we examined this issue, as well as factors predicting an abnormal scan, in a large cohort of patients referred subsequently. METHODS: We retrospectively identified 1,071 consecutive patients with chronic diarrhea undergoing SeHCAT scanning at Leeds Teaching Hospitals Trust from 2012 to 2016. We reviewed electronic patient records to obtain information on presenting gastrointestinal symptoms and any proposed risk factors for BAD. BAD was categorized according to subtype and severity. KEY RESULTS: As expected, indications for scanning changed between 2012 and 2016, with a significant reduction in referrals with TI Crohn's disease or resection year-on-year (P   40%. One-third of those without known risk factors had BAD.
📖 Papers frequently viewed together
5 Authors (Usman I. Aujla, ..., Sameer Zar)
6 Citations
#1Laura Ruiz-CamposH-Index: 1
#2Javier P. Gisbert (ISCIII: Carlos III Health Institute)H-Index: 103
Last. F. Fernández-Bañares (ISCIII: Carlos III Health Institute)H-Index: 6
view all 7 authors...
BACKGROUND: A limited number of small-sized studies suggest that bile acid diarrhoea is frequent in patients with chronic watery diarrhoea and previous cholecystectomy. AIM: To perform a systematic review and meta-analysis to assess the prevalence of bile acid diarrhoea in patients with chronic watery diarrhoea and previous cholecystectomy, and their response to colestyramine, including a new consecutive series of patients. METHODS: MEDLINE and EMBASE were searched up to January 2018. Selected s...
6 CitationsSource
#2Steven P. BrownH-Index: 1
Last. Julian R.F. Walters (Imperial College London)H-Index: 49
view all 13 authors...
Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality ...
72 CitationsSource
#1Matthew Kurien (University of Sheffield)H-Index: 16
#2Elizabeth ThurgarH-Index: 1
Last. Jervoise Andreyev (The Royal Marsden NHS Foundation Trust)H-Index: 14
view all 5 authors...
Background In 2012, the National Institute for Health and Care Excellence (NICE) assessed guidance (DG7) on the use of tauroselcholic ( 75 selenium) acid (also known as SeHCAT) for the investigation of diarrhoea due to bile acid malabsorption (BAM) in patients with IBS-D and in patients with Crohn’s disease who have not had an ileal resection. NICE concluded that tauroselcholic ( 75 selenium) acid was recommended for use in research only. NICE will be reviewing the decision to update the guidanc...
9 CitationsSource
#1James M Turner (Imperial College Healthcare)H-Index: 1
#2Sanjeev S. PattniH-Index: 8
Last. Julian R.F. Walters (Imperial College Healthcare)H-Index: 49
view all 4 authors...
Chronic diarrhoea is a common condition, resulting from a number of different disorders. Bile acid diarrhoea, occurring in about a third of these patients, is often undiagnosed. We hypothesised that a positive diagnosis of bile acid diarrhoea would reduce the need for subsequent investigations for alternative diagnoses. Methods Patients previously recruited to a study of chronic diarrhoea who had selenium homocholic acid taurine (SeHCAT) testing and subsequent follow-up at our institution were i...
21 CitationsSource
#1Iain A. Murray (Royal Cornwall Hospital)H-Index: 11
#2Linzi Karen Murray (Royal Cornwall Hospital)H-Index: 1
Last. Tom Sulkin (Royal Cornwall Hospital)H-Index: 3
view all 7 authors...
Aims: To determine the value of 75SeHCAT retention in determining bile acid diarrhoea (BAD), treatment response and predictors of a positive result.Methods: Retrospective casenote review of consecutive patients undergoing 75SeHCAT from 2008 to 2014, including gender, age, history, clinical, and laboratory parameters. This included diseases associated with Type 1 BAD (ileal resection, Crohn’s disease) and Type 3 BAD. Chi-squared test and logistic regression determined factors predictive of BAD. S...
6 CitationsSource
#1Nelson Valentin (Mayo Clinic)H-Index: 6
#2Michael Camilleri (Mayo Clinic)H-Index: 146
Last. M. Hassan Murad (Mayo Clinic)H-Index: 87
view all 7 authors...
There is no universally available laboratory test to diagnose bile acid diarrhoea (BAD). Objective To conduct a systematic review and meta-analysis to identify a biomarker for idiopathic BAD in patients with functional bowel disorder (FBD) with diarrhoea. Design We searched multiple databases through 15 May 2015. Data were only available to estimate the diagnostic yield of each test (the prevalence of a positive test). Estimates were pooled across studies using the random effects model. Results ...
63 CitationsSource
#1Jennifer Summers ('KCL': King's College London)H-Index: 10
#2Janet L. Peacock ('KCL': King's College London)H-Index: 61
Last. Fiona Reid ('KCL': King's College London)H-Index: 20
view all 10 authors...
Objective A clinical diagnosis of bile acid malabsorption (BAM) can be confirmed using SeHCAT (tauroselcholic ( 75 selenium) acid), a radiolabelled synthetic bile acid. However, while BAM can be the cause of chronic diarrhoea, it is often overlooked as a potential diagnosis. Therefore, we investigated the use of SeHCAT for diagnosis of BAM in UK hospitals. Design A multicentre survey was conducted capturing centre and patient-level information detailing patient care-pathways, clinical history, S...
15 CitationsSource
#1Imran Aziz (Royal Hallamshire Hospital)H-Index: 20
#2Saqib Mumtaz (St James's University Hospital)H-Index: 6
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 6 authors...
Background & Aims Some studies have found that patients with idiopathic bile acid diarrhea (BAD) present with symptoms of diarrhea-predominant irritable bowel syndrome (D-IBS). However, these studies either were retrospective, did not define D-IBS according to current criteria, or included patients with chronic functional diarrhea. We performed a prospective study of the prevalence of idiopathic BAD in consecutive patients fulfilling the Rome III criteria for D-IBS. Methods We analyzed data from...
46 CitationsSource
#1S. A. Slattery (QMUL: Queen Mary University of London)H-Index: 1
#2O. Niaz (Blackpool Victoria Hospital)H-Index: 1
Last. Adam D. Farmer (QMUL: Queen Mary University of London)H-Index: 26
view all 5 authors...
Summary Background Irritable bowel syndrome is a widespread disorder with a marked socioeconomic burden. Previous studies support the proposal that a subset of patients with features compatible with diarrhoea-predominant IBS (IBS-D) have bile acid malabsorption (BAM). Aim To perform a systematic review and meta-analysis to assess the prevalence of BAM in patients meeting the accepted criteria for IBS-D. Methods MEDLINE and EMBASE were searched up to March 2015. Studies recruiting adults with IBS...
94 CitationsSource
#1Fernando Fernández-Bañares (University of Barcelona)H-Index: 55
Last. Maria EsteveH-Index: 30
view all 8 authors...
Summary Background Idiopathic bile acid malabsorption (BAM) has been suggested as a cause of chronic watery diarrhoea, with a response to colestyramine in 70% of patients. However, the efficacy of this drug has never been investigated in placebo-controlled trials. Aim To evaluate the efficacy of colestyramine as compared with hydroxypropyl cellulose in the treatment of functional chronic watery diarrhoea. Methods Patients with chronic watery diarrhoea were randomly assigned to groups given coles...
28 CitationsSource
Cited By5
#1Chunxia Chang (Nanjing Medical University)H-Index: 1
#2Jingjing Jiang (SEU: Southeast University)H-Index: 1
Last. Hong Chen (Nanjing Medical University)H-Index: 1
view all 5 authors...
BACKGROUND Bile acid diarrhoea or BAD is a common but little recognised cause of chronic diarrhoea. Few of these patients in China have been diagnosed due to a lack of diagnostic options. AIMS To clarify the diagnostic value of serum fibroblast growth factor19 (FGF19) in BAD patients. METHODS We reported on 60 chronic diarrhoea patients and 80 healthy volunteers (HV). Based on the 90th percentile levels of serum 7a-hydroxy-4-cholesten-3-one (C4) of HV, these patients were divided into BAD group ...
1 CitationsSource
#1Christopher J Black (St James's University Hospital)H-Index: 12
#2Alexander C. Ford (St James's University Hospital)H-Index: 86
1 CitationsSource
#1Stefania Costa (UNIPV: University of Pavia)H-Index: 1
#2Serena Gattoni (UNIPV: University of Pavia)
Last. Federico Biagi (UNIPV: University of Pavia)H-Index: 38
view all 7 authors...
AIMS Bile-acid diarrhoea is a form of chronic diarrhoea caused by an excessive amount of bile reaching the colon. Conditions involving the terminal ileum and cholecystectomy are predisposing factors but an idiopathic form of bile-acid diarrhoea has also been described. The epidemiology and clinical course of this condition are still poorly defined. To evaluate the prevalence of bile-acid diarrhoea in patients consecutively evaluated for chronic diarrhoea in outpatient clinic. METHODS Clinical no...
#1Keeley M. Fairbrass (University of Leeds)H-Index: 1
#1Keeley M. Fairbrass (University of Leeds)H-Index: 2
Last. Alexander C. Ford (St James's University Hospital)H-Index: 86
view all 4 authors...
Summary Background Patients with inflammatory bowel disease (IBD) often report symptoms compatible with irritable bowel syndrome (IBS), which might have an effect on psychological health. However, previous estimates of the magnitude of this issue have not accounted for ongoing inflammation as the potential cause. We updated a previous systematic review and meta-analysis to determine prevalence of IBS-type symptoms in patients with IBD in remission to better quantify the magnitude of this issue. ...
6 CitationsSource
#1Christian BorupH-Index: 4
#2Signe WildtH-Index: 9
Last. Lars MunckH-Index: 40
view all 15 authors...
INTRODUCTION The diagnosis of bile acid diarrhea is often missed because the availability of the seleno-taurohomocholic acid (SeHCAT) test is limited. We aimed to compare the biomarkers 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor 19 (FGF19) with the SeHCAT test. METHODS Patients with chronic diarrhea without intestinal resection referred for SeHCAT were prospectively recruited for this diagnostic accuracy study. Blood was sampled at fasting and after a stimulation meal with ch...
3 CitationsSource